Some people find it hard to breathe when they are lying down flat. This is called orthopnea. It can happen for various reasons. The person may need to prop themselves up on pillows to sleep.

Doctors define orthopnea as “shortness of breath or difficulty breathing in [a] recumbent position,” or lying down. Heart failure is one reason for this. However, there are other possible causes.

Dyspnea is the name for shortness of breath, breathlessness, or difficulty breathing. A person may feel tightness in the chest or feel as though they cannot get enough air. Possible causes include congestive heart failure, obesity, and respiratory issues.

When breathing problems cause a person to wake up suddenly, it is called paroxysmal nocturnal dyspnea. Snoring and certain sleep disorders, such as obstructive sleep apnea (OSA), can have this effect.

This article will look at some causes and treatments for shortness of breath when lying down.

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One of the most common causes of orthopnea is heart failure.

In heart failure, the heart can no longer pump blood to the rest of the body as well as it should. It has trouble relaxing after squeezing. As a result, the pressures in the heart increase, and fluid backs up into the lungs, abdomen, or legs.

Other symptoms of heart failure are:

Researchers note that people with heart failure often sleep with the top part of their body raised, possibly to relieve breathing problems.

A doctor can prescribe medications to treat or manage heart failure. Lifestyle modifications can also help.

To treat orthopnea, a doctor may need to adjust a person’s diuretic medication to remove the fluid buildup from the lungs and reduce intracardiac pressures.

Learn about medications for heart failure.

COPD is a serious lung condition that comprises a group of diseases, including emphysema and chronic bronchitis. It usually occurs in people with a history of smoking. However, genetic factors, pollution, and passive smoking can also play a role.

COPD damages the air sacs in the lungs and makes the breathing tubes narrower, making it harder to breathe.

Breathing may be difficult when doing physical activity. However, it can also happen when a person is lying down.

The main symptoms of COPD include:

It is not possible to reverse the lung damage that occurs with COPD. However, quitting smoking can help slow further damage and relieve symptoms. Treatment aims to prevent further damage and manage symptoms.

Learn about medications for COPD.

People with excess weight or who live with obesity may have difficulty breathing when lying down.

As fat builds up in the body, it can affect the shape and function of the respiratory system and other structures.

These changes put pressure on structures in the chest wall, affecting the movement of the diaphragm and the body’s ability to respond when a person breathes in and out. When a person lies down, the additional fat presses on the lungs, making breathing harder.

Obesity has also been linked with inflammation, which may also affect lung tissue, according to scientists.

Obesity has links to various other health conditions, including heart disease, which can also lead to or worsen orthopnea and dyspnea.

Losing weight can help ease orthopnea. A doctor can advise on suitable ways to lose weight, usually through dietary choices and exercise.

Find some tips for losing weight here.

Obstructive sleep apnea (OSA) involves breathing difficulties while sleeping. There are different types of sleep apnea. However, they all have similar symptoms.

A person with sleep apnea:

  • may snore
  • will pause their breathing while asleep
  • will make gasping and choking sounds

OSA can affect a person’s quality of sleep and may be a sign of another disorder, such as congestive heart failure. It is essential to seek treatment due to the risk of complications.

How do you find treatment for sleep apnea and what does it involve?

The diaphragm is the muscle people use to breathe.

In diaphragm paralysis, the diaphragm becomes unable to contract, for example, due to nerve or muscle damage. It can be a cause of orthopnea.

To treat diaphragm paralysis, a doctor will first address the underlying cause. For example, they may give antiviral medication if there are signs of a viral infection. Or, they may carry out a procedure to decompress the phrenic nerve, the nerve which leads to the diaphragm.

In some cases, a person may need breathing support or surgery.

What is the link between the diaphragm and paradoxical breathing?

Another possible cause of orthopnea is pleural effusion.

Pleural effusion is when fluid collects in the pleural cavity, which surrounds the lungs.

Possible causes include an infection, cancer, or a pulmonary embolism. There may also be no clear reason.

There may be no symptoms. However, a person with an underlying condition may notice pain when they breathe or cough. Without treatment, breathing problems can arise.

Learn about empyema, when pus collects in the pleural space.

Pneumonia can also lead to breathing difficulty when a person is lying down.

Pneumonia is a lung infection. It can be bacterial, viral, or fungal. It can also develop as a complication of COVID-19.

A person with pneumonia may have:

Treatment will depend on the cause of pneumonia. It is a potentially life threatening condition, and anyone with signs of pneumonia should seek medical advice. If the person has difficulty breathing, they need emergency help.

How can people ease the symptoms of pneumonia at home?

Ascites is fluid that builds up in the body, often due to liver disease.

Other possible causes include:

  • obesity
  • alcohol consumption
  • pancreatic problems
  • type 2 diabetes
  • cancer

A person may notice:

  • shortness of breath
  • abdominal discomfort
  • weight gain
  • feeling full soon after eating

When fluid collects in the abdomen or chest area, it can put pressure on organs in the abdomen, such as the lungs. This can affect a person’s ability to breathe, including when lying down.

Learn about the link between ascites and ovarian cancer.

People who experience panic, anxiety, and fear may find these symptoms worsen when they are lying down in a dark room. Breathing difficulty can occur with panic and fear. However, doctors do not usually refer to this as orthopnea.

Symptoms of a panic or anxiety attack include:

  • shortness of breath
  • feelings of choking
  • pain and discomfort in the chest

Panic and anxiety can happen anytime, and anxiety at night is common.

Treatment options for panic and anxiety include anxiety medications, counseling, psychotherapy, and cognitive behavioral therapy.

Learn about treatments to help manage anxiety.

Shortness of breath can be a cause for concern.

A person should seek medical advice if they experience:

  • frequent, ongoing, or unexplained shortness of breath
  • any new or worsening breathing problems
  • other symptoms, such as dizziness, pain, a fever, or fatigue

A person should seek emergency medical help if they have severe breathing difficulty or a blue tinge to the lips or nail beds, which can indicate low oxygen levels.

Learn how to manage shortness of breath at home.

Orthopnea is the medical term for shortness of breath when lying down. It can result from a range of health conditions, including heart failure and obesity.

Treatment will depend on the underlying cause. However, sleeping with the heads propped up on pillows may help manage symptoms. For people with obesity, losing weight can help.

A person should seek medical help if they have sudden or unexplained shortness of breath or breathing difficulties accompanied by chest pain, fainting, a fever, or nausea.